The additive impact of reduced symptom-to-door and door-to-balloon times on survival rates in acute ST-elevation myocardial infarction patients

Abstract

Background: Shortened door-to-balloon time (D2B) has been documented to confer cardiovascular benefits for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). However, prolonged myocardial ischemic duration usually negates the beneficial effects due to delayed symptom-to-door time (S2D). In this study, we sought to investigate the joint effect of S2D-D2B in predicting clinical outcomes.

Methods: This study retrospectively enrolled 342 consecutive STEMI patients receiving PPCI. The baseline demographic data, clinical features, S2D, D2B, and S2B were compared between survivors and non-survivors. We further analyzed the relationships between mortality rates and S2D/D2B in patients with different age categories.

Results: The receiver-operating characteristic curves analysis revealed D2B time 65. Mins, S2D time 125 min, and S2B time 170 min had the greatest predictive power for mortality rate. Patients with D2B < 65min and S2D time <125 min had the lowest mortality rate (1.62%). Whereas, patients with a D2B ≥ 65 min and S2D ≥ 125 min had the highest mortality rate (21%, P = 0.0004). Multiple variate analyses showed that combined D2B ≥ 65 min and S2D ≥ 125 min was an independent predictor for a higher mortality rate (HR 9.44, P = 0.0111). Shorter S2B time was also associated with a lower mortality rate in overall and younger populations.

Conclusions: The reductions of both D2B and S2D were associated with improved mortality rates in STEMI patients receiving PPCI, especially in younger populations. The findings call for community and healthcare system efforts to address these critical time intervals to enhance survival rates in STEMI patients.

Keywords: Door-to-balloon time; Mortality rate; ST-elevation acute myocardial infarction; Symotom-to-balloon time; Symptom-to-door time.